DIFFERENTIAL DIAGNOSIS OF THE DYSENTERIES 219 



tions of bacillary dysentery may be watery or serous, and the truth 

 may not be apparent until the mucus has been carefully examined 

 microscopically.^ Late in the course of a fulminating dysentery, 

 when the epithelium has been stripped from the bowel, the move- 

 ments will contain no mucus and little else besides blood and 

 serum. 



Movements of bacillary dysentery, especially those of the tena- 

 cious mucoid type, frequently contain so little blood that it is 

 discovered only on microscopic examination. This is misleading to 

 the uninitiated and frequently leads to the assumption that the 

 condition is not one of dysentery. 



Purulent movements are encountered in suppurative conditions 

 in the intestine following dysentery or consequent upon a variety 

 of surgical or malignant conditions. IMuch work remains to be 

 done on stools of this type because of the confusing pictures they 

 present in connection with the diagnosis of dysentery. The base 

 of these stools usually is feculent, but the accompanying exudate 

 is purulent in the true sense. Frequently the pus is found closely 

 adherent to the fecal mass, in which event it usually is mixed with 

 mucus of a tough, tenacious kind, or it may occur as a separate 

 portion consisting of a creamy mass of leucocytes and other cells. 

 It is quite similar to the drainage from a suppurating wound.^ I 

 already have described types of these movements in the publica- 

 tions cited. 



Needless to say, no study of these conditions can be complete 

 without tests for occult blood. The benzidin reaction is simple and 

 sufficiently sensitive for preliminary work. It should be appHed 

 with the subject on a diet free from meats and green vegetables. 

 The sample of stool under examination should be carefully ex- 

 tracted with neutral ether before the test is applied in order to 

 get rid of the fats. 



We now come to a flagrantly neglected, though vitally impor- 



* No matter what type of stool is under examination, search always should 

 be made for mucus and if it is found it should undergo careful microscopic 

 examination. The preparations always should be stained. 



°A mistake that one frequently comes across in the literature is the use 

 of the word purulent when the more correct term would be foul. Purulent 

 signifies inflammation and pus, whereas foul may signify nothing worse 

 than a bad smell. The error may be most misleading for a purulent stool 

 is the expression of definite pathology, while foul may be applied to a 

 variety of stools that are not pathological in any sense. 



